Multiple Sclerosis (MS)
โรค Multiple sclerosis MS
What causes MS?
are the symptoms
Who gets MS?
What are the types of
Multiple Sclerosis (MS)
Multiple Sclerosis (MS) มัลติเปิ้ล
MS is one of the most common diseases of the central nervous system in young
Sclerosis means scars these are the plaques or lesions in the brain and spinal
In MS, the protective myelin covering of the nerve fibres in the central nervous system is
Inflammation and ultimate loss of myelin causes disruption to nerve transmission and affects many functions of the
While the exact cause of MS is not known, much is known about its effect on immune system function which may be the ultimate cause of the
MS is not directly hereditary, although genetic susceptibility plays a part in its
MS is not contagious
More women than men have MS
Diagnosis of MS is generally between 20 and 40 years of age, although onset may be
MS is rarely diagnosed under 12 and over 55 years of age
Life span is not significantly affected by MS
Fatigue is a common symptom of MS
MS is more common in countries further from the equator
Heat can cause symptoms to worsen temporarily in many people with MS
There is no drug that can cure MS, but treatments are now available which can modify the course of the
Your doctor and your national MS society are important sources of information about
Many of the symptoms of MS can be successfully managed and treated
Multiple Sclerosis is one of the most common diseases of the central nervous system (brain and spinal cord). MS is an inflammatory demyelinating condition. Myelin is a fatty material that insulates nerves, acting much like the covering of an electric wire and allowing the nerve to transmit its impulses rapidly. It is the speed and efficiency with which these impulses are conducted that permits smooth, rapid and co-ordinated movements to be performed with little conscious effort. In Multiple Sclerosis, the loss of myelin (demyelination) is accompanied by a disruption in the ability of the nerves to conduct electrical impulses to and from the brain and this produces the various symptoms of MS. The sites where myelin is lost (plaques or lesions) appear as hardened (scar) areas: in Multiple Sclerosis these scars appear at different times and in different areas of the brain and spinal cord - the term Multiple Sclerosis meaning, literally, many scars.
What causes MS?
The cause of Multiple Sclerosis is not yet known, but thousands of researchers all over the world are meticulously putting the pieces of this complicated puzzle together. The damage to myelin in MS may be due to an abnormal response of the body's immune system, which normally defends the body against invading organisms (bacteria and viruses). Many of the characteristics of MS suggest an 'auto-immune' disease whereby the body attacks its own cells and tissues, which in the case of MS is myelin. Researchers do not know what triggers the immune system to attack myelin, but it is thought to be a combination of several factors. One theory is that a virus, possibly lying dormant in the body, may play a major role in the development of the disease and may disturb the immune system or indirectly instigate the auto-immune process. A great deal of research has taken place in trying to identify an MS virus. It is probable that there is no one MS virus, but that a common virus, such as measles or herpes, may act as a trigger for MS. This trigger activates white blood cells (lymphocytes) in the blood stream, which enter the brain by making vulnerable the brain's defence mechanisms ( i.e. the blood/brain barrier). Once inside the brain these cells activate other elements of the immune system in such a way that they attack and destroy myelin.
are the symptoms of MS?
Multiple Sclerosis is a very variable condition and the symptoms depend
on which areas of the central nervous system have been affected. There
is no set pattern to MS and everyone with MS has a different set of
symptoms, which vary from time to time and can change in severity and
duration, even in the same person. The systems commonly affected
- speech and
There is no typical MS. Most
people with MS will experience more than one symptom, and though there
are symptoms common to many people, no person would have all of them.
- blurring of vision
- double vision (diplopia)
- optic neuritis
- involuntary rapid eye
movement (rarely) total
loss of sight
& co-ordination problems:
- loss of balance
- unstable walking (ataxia)
- giddiness (vertigo)
- clumsiness of a limb
- lack of co-ordination
- this can particularly affect
the legs and walking
- altered muscle tone can
produce spasticity or muscle stiffness which can affect mobility
- tingling, numbness (paraesthesia),
or burning feeling in an area of the body
- other indefinable sensations
may be associated with MS, e.g. facial pain, (such as trigeminal
neuralgia), and muscle pain
- slowing of speech
- slurring of words
- changes in rhythm of speech
- Difficulty in swallowing (dysphagia)
- a debilitating kind of
general fatigue which is unpredictable or out of proportion to the
activity. Fatigue is one of the most common (and one of the most
troubling) symptoms of MS
& bowel problems:
- bladder problems include the
need to pass water frequently and/or urgently, incomplete emptying
or emptying at inappropriate times.
- bowel problems include
constipation and, infrequently, loss of bowel control
- diminished arousal
- loss of sensation
For more information see 'Relationships,
Intimacy & Sexuality' section of WoMS
Sensitivity to heat:
- this symptom very commonly
causes a transient worsening of symptoms
& emotional disturbances:
- problems with short term
memory, concentration, judgment or reasoning
For more information see MS by
Topic - 'Cognitive
Whilst some of these symptoms are
immediately obvious, others such as fatigue, altered sensation, memory
and concentration problems are often hidden symptoms. These can be
difficult to describe to others and sometimes family and carers do not
appreciate the effects these have on the person with MS and on
employment, social activities and quality of life.
Who gets MS?
Women are more likely to develop Multiple Sclerosis than men, MS occurring 50% more frequently in women than in men (i.e. 3 women for every 2 men). Multiple Sclerosis is a disease of young adults, the mean age of onset is 29-33 years, but the range of onset is extremely broad from approximately 10-59 years. With the advent of specialized diagnostic markers such as the Magnetic Resonance Imaging scanner
(MRI) there are cases of MS being definitely diagnosed in childhood rather than in adolescence and the 15 years lower age limit which is traditionally quoted in many texts and handouts should not be taken as a fixed boundary for onset of the disease. MS is not contagious, your friends and family cannot catch it from you. MS is not an inherited disease, nor is it genetically transmitted, but there does appear to be some genetic susceptibility to the disease, which explains the fact that there is a slightly higher risk of Multiple Sclerosis in families where it has already occurred. The slightly increased risk to children and siblings of those with MS may reflect a common susceptibility and a similar environment. It is important to establish who is most likely to develop MS and the geographic areas of highest incidence. In the world map of MS prevalence, MS appears to be a disease of temperate rather than tropical climates (i.e. there is more MS the further one lives from the equator). In Northern Europe, particularly Scandinavia and Scotland, there is a high incidence of MS, which may reflect a specific susceptibility of the native population. Migration at particular ages can affect susceptibility to developing MS. A child migrating from an equatorial to temperate area (or temperate to equatorial) before puberty acquires the risk of the area to which he/she has moved. The same relocation by an adolescent (or older person) retains the risk characteristic of the area from which he/she moved.
What are the types of MS?
The course of MS is unpredictable. Some people are minimally affected by the disease while others have rapid progress to total disability, with most people fitting between these two extremes. Although every individual will experience a different combination of MS symptoms there are a number of distinct patterns relating to the course of the disease:
In this form of MS there are unpredictable relapses (exacerbations, attacks) during which new symptoms appear or existing symptoms become more severe. This can last for varying periods (days or months) and there is partial or total remission (recovery). The disease may be inactive for months or years.
Frequency - approx 25%
After one or two attacks with complete recovery, this form of MS does not worsen with time and there is no permanent disability. Benign MS can only be identified when there is minimal disability 10-15 years after onset and initially would have been categorised as relapsing-remitting MS. Benign MS tends to be associated with less severe symptoms at onset (e.g. sensory).
Frequency - approx 20%
Secondary Progressive MS:
For some individuals who initially have relapsing-remitting MS, there is the development of progressive disability later in the course of the disease often with superimposed relapses.
Frequency - approx 40%
Primary Progressive MS:
This form of MS is characterised by a lack of distinct attacks, but with slow onset and steadily worsening symptoms. There is an accumulation of deficits and disability which may level off at some point or continue over months and years.
Frequency - approx 15%
Early MS may present itself as a history of vague symptoms
which may have subsided and many of the signs could be attributed to a
number of medical conditions. Therefore, a period of time may elapse and
a prolonged diagnostic process may be involved before MS is suggested.
On the other hand, a possible diagnosis of MS may be more clearcut with
classic symptoms (e.g. optic neuritis) and a distinct chronology of
attacks. The neurologist requires evidence that the types of
neurological deficits indicate involvement of at least two different
areas of the central nervous system with effects occurring at two
Multiple Sclerosis is essentially
a clinical diagnosis and there are no tests which are specific for the
condition and no single test is 100% conclusive. Therefore several tests
and procedures are needed to establish a diagnosis of MS and they
include the following investigations:
- Medical History
- The physician will ask for a
medical history which will include your past record of signs and
symptoms as well as the current status of your health. The type of
symptoms, their onset and pattern may suggest MS, but a full
physical examination and medical tests will be needed to confirm
- The neurologist is testing
for abnormalities in nerve pathways. Some of the more common
neurologic signs involve changes in eye movements, limb
co-ordination, weakness, balance, sensation, speech, and reflexes.
However, this examination cannot conclude what is causing the
abnormality and so other possible causes of illness which produce
similar symptoms to MS must be eliminated.
- Testing of
Visual and Auditory Evoked Potentials
- When demyelination
(scarring) occurs the conduction of messages along the nerves may
be slowed. Evoked potentials measure the time taken for the brain
to receive and intepret messages (nerve conduction velocity). This
is done by placing small electrodes on the head which monitor
brain waves in response to visual and auditory (hearing) stimuli.
Normally, the brain's reaction to such stimuli is almost
instantaneous, but if there is demyelination in the central
nervous system a delay may occur. This test is not invasive or
painful and therefore does not require a stay in hospital.
Resonance Imaging (MRI)
- The MRI scanner is a more
recent diagnostic test and takes very detailed pictures of the
brain and spinal cord, showing any existing areas of sclerosis
(lesions or plaques). Whilst this is the only test in which the
lesions of Multiple Sclerosis can be seen, it cannot be regarded
as conclusive, particularly as not all lesions may be picked up by
the scanner and because many other conditions can produce
identical abnormalities. The MRI clearly shows the size, quantity
and distribution of lesions, and together with supporting evidence
from medical history and neurologic examination, is very
significant indicator toward confirming the diagnosis of MS
- The MRI is also a very
useful tool in clinical trials in assessing the value of new
therapies by its ability to measure disease activity in the brain
and spinal cord
- Lumbar Puncture
- In this test, cerebrospinal
fluid (the fluid which flows around the brain and spinal cord) is
tested for the presence of antibodies. Antibodies can occur with
MS but they can also occur with other neurological conditions. The
fluid is taken from the spinal cord by inserting a needle into the
back and withdrawing a small amount of fluid. A local anaesthetic
is given to numb the skin, and therefore whilst it is
uncomfortable it is not usually painful. This test does require
the person to lay flat for a number of hours after the test, and
may require an overnight stay in hospital. Subsequently for some,
a short period of recuperation may be required. This test may
indicate MS but is not in itself conclusive
The diagnosis of MS is not always
clear cut. The initial symptoms may be transitory and vague and
confusing to both the person and their doctor. Invisible or subjective
symptoms are often difficult to communicate to doctors and health
professionals and sometimes people are at first dismissed as being
neurotic or a hypochondriac.
Following an episode for which
you have sought medical advice, your doctor may not have told you that
MS is suspected. This delay may be very reasonable because the
neurologist may wish to witness at least two distinct episodes with
symptoms that are separated by at least a month and persisting for at
least 24 hours.
A good relationship with your
neurologist and family physician is essential. MS may have times of
crisis and acute episodes which require specialist medical attention,
but it is a disease that must be lived and managed every day. The time
of diagnosis is stressful not only for the person with MS but for the
family and carers who should also be fully informed as to the diagnosis,
prognosis, treatment, management considerations and lifestyle
adjustments associated with MS. The family physician and the local
MS Society are important ongoing resources for care and information
for those affected by MS.
The diagnosis of MS is a shock
and often stereotypes of wheelchairs and disability tend to dominate
one's thoughts. Nevertheless, it is most important to realise that many
people with MS and their carers have recognised that it is still
possible to live life to the full, taking into account any limitations
caused by the illness. Thus, it is often unnecessary to give up work,
education and social activities. Many people with MS can lead
productive, fulfilling and relatively normal lives.
Currently there are a number of different drugs available for MS which are not directly related to symptom management and which may act to alter the course
of the disease. (See also FAQ 'Is there any Treatment for MS' and MS MANAGEMENT Vol 3 No 2 Nov 1996 )
There are three beta interferons (Betaferon, Avonex, Rebif) and glatiramer acetate (Copaxone) and the features of each are different (eg method and frequency of injection).
All these drugs have an impact on the frequency and severity of relapses, and the number of lesions as seen on MRI scans. Some of the drugs appear to have an effect of slowing the progression of disability.
Decisions as to whether an individual is suitable for these medications, whether they should go on a drug and finally which one to choose, are matters for consultation between the person with MS and his/her medical advisors (neurologist, family physician). There are also particular considerations of availability, cost, health service attitudes etc which will also impact on the decision making process.
This section will provide separate information about each of these drugs in the form of a series of frequently asked questions and answers.
Avonex (coming soon)
Rebif (coming soon)